Provider Demographics
NPI:1972984755
Name:OTKEN, ANDREA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:OTKEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 PIEDMONT AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4308
Mailing Address - Country:US
Mailing Address - Phone:727-265-0804
Mailing Address - Fax:
Practice Address - Street 1:925 COMMERCIAL ST SE STE 260
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4288
Practice Address - Country:US
Practice Address - Phone:503-391-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor